Archives for September 2008


| NFL |
Refs will wear pink

During October, NFL officials will wear a pink ribbon patch and a pink bracelet to honor National Breast Cancer Awareness Month.

It’s the second consecutive year the NFL Referee Association has partnered with Dallas-based Susan G. Komen for the Cure.

The partnership will be formally announced Sunday at Texas Stadium before the Cowboys’ game against Washington. NFLRA officials will present a check to Komen representatives.

That’s kinda nice.  They were wearing them for the Monday Night game (on September 29), so I wonder if that crew got the memo.

Guest Photo, and a Caption Contest

A reader wrote to offer a picture taken in his ED, and it’s not just an excellent photo, it begs for a caption contest!


His introduction to the photo: “Just walked in to start my shift at 6:30am and this was sitting on the counter…”


Joel Goldberg, MD Grand Rapids, MI

Photo courtesy Joel Goldberg, MD Grand Rapids, MI


As usual, the rules for a caption contest here: Put you submission in the comments, I decide the winner, and the prize is the pride you get from lording your superior captioning skills over the losers other submissions.  Polls close in a week, or when there’s a clear winner.

CDC: Mildest season in 7 years for West Nile Virus –

CDC: Mildest season in 7 years for West Nile Virus –
ATLANTA, Georgia (AP) — The West Nile virus season is on track to be the mildest in seven years, with less than a third the number of serious cases as last year’s total, U.S. health officials said.
The CDC recommends using insect repellent to protect against mosquito bites.

The CDC recommends using insect repellent to protect against mosquito bites.

As of Tuesday, there were 368 severe cases, with 18 deaths, according to preliminary reports. Mississippi and California were hardest hit, together accounting for nearly half the cases.

It’s now in its endemic phase.  Barring some antiviral breakthrough, it’ll be with us in North America forever. – For Sale: Revolution Health

For Sale: Revolution Health

Why is Steve Case’s online health venture already looking to sell itself, just a year and a half after it launched? Yet another tale of hubris in the e-health sector.

John Grohol at has a very good post about the problems of medical startups on the web.  It’s well written and informative, including his perspective from having been in the same boat before.

I do think he’s missed the other act of hubris, that fundamental change in our medical system can be brought about by a company with a professional website, writers with credentials, etc.  That’s good for entertainment, so far as it goes, but it’s not a terrifically efficient way to shape healthcare policy.  (The New York Times has all those things, works hard to affect policy, and is not very effective at getting their ideas enacted as national policy.  Also, the NYT has deep pockets and has been engaged in the arena for a very long time, demonstrating the long time horizon necessary to have influence).

This puts Dr. Val’s blog homelessness into perspective (but I wonder what’s to become of some of the others)?

Naughty Radiology Tech

Well, I learn something new every day from blogging. Thanks to TBTAM for the wart therapy tip: pregnancy can cure warts? I’m not sure if I’m THAT desperate yet. And what would I say to my child – yeah, daddy and I didn’t really want to have a kid, we just wanted to cure our plantar wart? Lol.

Here’s an ER themed cartoon for you trauma folks. Enjoy!

An Alternative to the Joint Commission

I wonder how many hospitals are looking into this alternative from the Joint Commission and their mission creep via ModernHealthcare:

CMS grants accrediting authority to DNV Healthcare

Story posted: September 25, 2008 – 5:59 am EDT

The CMS will allow Det Norske Veritas Healthcare to accredit U.S. hospitals, a move that puts the company in a small group of “deemed” organizations and could bring an increased focus on international standards, most notably ISO 9001, to hospitals across the country.

…DNV Healthcare is expected to certify healthcare organizations as compliant with ISO 9001 quality management standards, as well as the Medicare conditions of participation.

The company’s authority to accredit hospitals will run through September 26, 2012.

Well, now. 

I wonder if my iphone posts

Let’s find out.

Yes!  Yes it does.

A Wart And The “Keys To The Kingdom”

As many of my close followers know, I’m “in between blogs” at the moment. My new website has not launched yet, so I’ve asked a few close friends if I could guest-blog at their sites until further notice. Dear Grunt Doc actually offered me a password and authority to post directly to his blog. Now that’s trusting! I mean, I could fill up his site with LOLcats posts if I wanted.

A few blog-hijacking fantasies later, I decided to ask myself – “What sort of content would be appropriate to contribute to an Emergency Medicine blog?” The answer, of course, is “real photos of anything gross.”

And as luck would have it, I do have a nice photo of something gross (albeit mildly so). Even better, it’s my own grossness so there’s no HIPAA violation looming. What is it? Well, it’s the sadistic work of a dermatologist. (By the way, dermatologists have the best photo galleries of really gory conditions).

Let me explain.

You know how every once in a while in life you think, “Gee, this is a really bad idea” but then you go ahead with it anyway? That happened to me 7 years ago. I had accompanied a friend to a hair salon in Rochester, New York. And since the process of having her hair colored would take about 2 hours, I figured I’d find something to amuse myself. The salon offered manicures and pedicures. So I opted for a pedicure.

A little voice inside me said, “Is it hygienic to do a pedicure in a plastic tub with tools that don’t look as if they’ve been sterilized?” But then I figured, “it’ll be fine.”

A few weeks later I noticed a plantar wart on the heel of my foot. “Crap. I guess I’ll just go and have my PCP freeze it off.” Sounds easy enough – but 7 years later I have to tell you that this wart virus is still alive and kicking. Here’s what I’ve hit it with:

Liquid nitrogen Q month x 24 months, salicylic acid pads QD x 12 months, duct tape, OTC wart spray, podofilox topical solution, aldara cream (costs $500/3 month supply), bleomycin injection (that’s the chemo that can cause pulmonary fibrosis), and now blistering acid solution.

I had the “blistering acid” applied yesterday. And it’s 4:30 am and I was awoken by a sharp pain in my foot. So I got up and saw – you guessed it – blood blisters on the bottom of my foot. Yum! Not to be outdone by Paul Levy, I snapped a photo for Grunt Doc’s blog, feeling very satisfied with my contribution.

Here it is:

What on earth is the moral of this story? Ladies (and a few gents), if you have any doubt about the hygiene practices of your local nail salon – do NOT override your instincts. Just remember my story, and how I discovered the virus that will survive a nuclear war. If this series of blistering acid treatments doesn’t do the trick, I’m coming to GD’s ER for a wide excisional biopsy. God bless EMTALA.

P.S. If the injury site begins to look really gross, I’ll snap you another photo!

Aging Eyes and Safety

So, you’re a doc and you don’t focus up close like you used to, but you still need eye protection on the job.  What to do?



Apply the stick-on bifocals from a drug store.  He says they work very well.

MedBlogs Grand Rounds 5:1

Kicking off the Fifth Year of Grand Rounds is one of Medblogging’s brightest lights, Dr. Val Jones, of Revolution Health.  Except it’s not there, and it’s not at her new place (not open for blogging yet), which begat the clever decision to post Grand Rounds at two different powerhouse blogs:  Emergiblog and Kevin, MD (looks like the same at both places).

Welcome to the historic, 5th year anniversary of Grand Rounds, the weekly summary of the best of the medical blogosphere. As the proud new co-leader of Grand Rounds, I am committed to expanding its reach, promoting the Grand Rounds “brand,” and making sure contributors’ voices are heard by healthcare’s movers and shakers.
This day happens to be historic for me as well, since I have just taken the leap into blogging independence. I’m excited that “Dr. Val and the Voice of Reason” lives on at the Getting Better Blog. I am committed to integrity, transparency, and medical accuracy – presented in a warm, and down-to-earth manner. Unfortunately, my new site is not live yet, so KevinMD and Kim from Emergiblog have graciously allowed me to crash guest blog at their sites for this edition of Grand Rounds.

A nice edition, and I really like the new logo.

Movin’ Meat: Cell Phones

Movin’ Meat: Cell Phones


Slow Night


Aggravated DocSurg: A Cultural Chasm

Aggravated DocSurg: A Cultural Chasm
…I am sorry, but I do not think that “structured dialogue and inquiry” means anything other than sitting in meetings with administrators on my time while they decide whether or not my opinion is worth listening to.

He’s not sorry, and he’s on a roll.  The video in this rant is kinda funny (and there must me some internet tool that puts subtitles on this particular video, as I’ve seen it several times for different rants).

Breathe, by the Laryngospasms

You probably saw this today at Kevin, MD’s place, but in case you missed it there, enjoy a cappella singing by CRNA’s.



Tech Bleg

Do any of you know the answer to the following?

I want to attach a network switch at a location remote from my wireless router.  Would a wireless adapter plugged into a switch work, or no?

Update: I didn’t give nearly enough info initially, so here’s what I have:.  In one end of the house is my internet connection, going through a Linksys wireless router.  I have the router attached to a set of Netgear powerline ethernet adapters, as the wireless signal on the other end of the house is very very low.

I tried putting a linksys 5port switch on the Remote Netgear adapter, and nothing will connect through it, though the hardware will connect when plugged directly into the netgear wireline adapter.  I have about 4 things in that room I want to attach to the network, by the way.

I threw out the wireless adapter thing as a SWAG, but wonder if I need to attach a router to the netgear wireline adapter (instead of the switch) to make that work?

Update2: The Denoument of Stupid.  My original setup works.  Switch ok attached to the Netgear adapter.  Apologies to all, thanks for the suggestions.